[ OP-ED COLUMN ]

Chronic Illness? Pick Plan Carefully

To avoid paying the penalty for not having insurance, consumers must enroll in a plan by March 15. This leaves plenty of time to make the right choice.

By RICK McCOLLUM

Published: Tuesday, November 19, 2013 at 12:01 a.m.

Last Modified: Monday, November 18, 2013 at 11:29 p.m.

The open enrollment period has begun for the Affordable Care Act and is scheduled to close March 31. Many different organizations are working to educate consumers about these new health care options, because it is a significant personal decision.

Floridians must keep in mind that the plan they choose today cannot be changed until the next enrollment period.

Florida is participating in the federal exchange, which offers four plan levels: platinum, gold, silver and bronze — each level corresponds to the portion of the health care costs that the plan covers, ranging from most generous to least generous.

Although bronze plans may have the lowest premiums, they will have the highest deductibles and cost-sharing, whereas platinum plans have the highest premiums and lowest out-of-pocket costs.

It is also significant to note that, while premium support for those between 100 percent and 400 percent of the federal poverty level applies to all plans, cost-sharing assistance is only available in silver-level plans.

It is extremely important that those facing chronic diseases, such as lupus, pay careful attention to what is offered under the health plans.

Lupus is an autoimmune disease with which I am quite familiar. It can manifest itself in the joints, blood and kidneys. In most cases, lupus isn't fatal but, as with many chronic illnesses, successfully managing lupus requires regular treatment and close monitoring by medical professionals.

When evaluating the health plans to find one that fits your needs, I recommend estimating your predictable health needs and expenses. There are a few things to keep in mind when choosing a plan through the health exchange.

First, consider whether your doctor or hospital is in your plan.

Access to doctors in a plan network — particularly specialists — may be limited in plans purchased on the health exchange. Knowing which providers are covered is vital for those who have lupus and other chronic diseases.

Second, consider how your prescription drugs will be affected — specifically, whether your prescription drugs will be carried on the preferred drug list and what they will cost. Unfortunately, some plans will likely impose significant barriers to innovative medicines.

Third, find out what the covered benefits are under the plan and whether they include services that you know you and your family will need. Although plans offered under the health exchange cover certain key benefits, there will be some variation in services throughout the plans.

Lastly, make sure that you understand your out-of-pocket expenses. These expenses are not limited to premiums or direct medical expenses. They can include deductibles, copays, coinsurance and off-formulary prescription-drug costs if the insurer has issued an exception.

If you are in the market in Florida for one of the plans offered through the federal health exchange, remember that there is no rush. To avoid paying the penalty for not having insurance, consumers must enroll in a plan by March 15. This leaves plenty of time to make the right choice.

Individuals, particularly those with life-changing and life-threatening diseases, need to be sure to closely evaluate their plan choices. Those who have chronic diseases such as lupus already face enough day-to-day challenges.

The details provided in your plan could determine your ability to live a normal, productive life through access to quality doctors, therapists and proper prescription regimens.

[ Rick McCollum is president and CEO of the Lupus Foundation of Florida, St. Petersburg. ]

<p>The open enrollment period has begun for the Affordable Care Act and is scheduled to close March 31. Many different organizations are working to educate consumers about these new health care options, because it is a significant personal decision.</p><p>Floridians must keep in mind that the plan they choose today cannot be changed until the next enrollment period.</p><p>Florida is participating in the federal exchange, which offers four plan levels: platinum, gold, silver and bronze — each level corresponds to the portion of the health care costs that the plan covers, ranging from most generous to least generous.</p><p>Although bronze plans may have the lowest premiums, they will have the highest deductibles and cost-sharing, whereas platinum plans have the highest premiums and lowest out-of-pocket costs.</p><p>It is also significant to note that, while premium support for those between 100 percent and 400 percent of the federal poverty level applies to all plans, cost-sharing assistance is only available in silver-level plans.</p><p>It is extremely important that those facing chronic diseases, such as lupus, pay careful attention to what is offered under the health plans.</p><p>Lupus is an autoimmune disease with which I am quite familiar. It can manifest itself in the joints, blood and kidneys. In most cases, lupus isn't fatal but, as with many chronic illnesses, successfully managing lupus requires regular treatment and close monitoring by medical professionals.</p><p>When evaluating the health plans to find one that fits your needs, I recommend estimating your predictable health needs and expenses. There are a few things to keep in mind when choosing a plan through the health exchange.</p><p>First, consider whether your doctor or hospital is in your plan. </p><p>Access to doctors in a plan network — particularly specialists — may be limited in plans purchased on the health exchange. Knowing which providers are covered is vital for those who have lupus and other chronic diseases.</p><p>Second, consider how your prescription drugs will be affected — specifically, whether your prescription drugs will be carried on the preferred drug list and what they will cost. Unfortunately, some plans will likely impose significant barriers to innovative medicines.</p><p>Third, find out what the covered benefits are under the plan and whether they include services that you know you and your family will need. Although plans offered under the health exchange cover certain key benefits, there will be some variation in services throughout the plans.</p><p>Lastly, make sure that you understand your out-of-pocket expenses. These expenses are not limited to premiums or direct medical expenses. They can include deductibles, copays, coinsurance and off-formulary prescription-drug costs if the insurer has issued an exception.</p><p>If you are in the market in Florida for one of the plans offered through the federal health exchange, remember that there is no rush. To avoid paying the penalty for not having insurance, consumers must enroll in a plan by March 15. This leaves plenty of time to make the right choice.</p><p>Individuals, particularly those with life-changing and life-threatening diseases, need to be sure to closely evaluate their plan choices. Those who have chronic diseases such as lupus already face enough day-to-day challenges.</p><p>The details provided in your plan could determine your ability to live a normal, productive life through access to quality doctors, therapists and proper prescription regimens.</p><p>[ Rick McCollum is president and CEO of the Lupus Foundation of Florida, St. Petersburg. ]</p>